In this article, James Nowosielski reviews the structures involved in Baxter’s nerve entrapment and unpacks how clinicians can help their athletes recover.
Rajiv Gandhi International Cricket Stadium, Hyderabad, India - India’s Rohit Sharma in action REUTERS/Francis Mascarenhas
When it comes to foot pain, the heel is the most common complaint, and typically, it is associated with the plantar fascia(1). Plantar fasciitis is challenging to treat, and rehabilitation can frustrate the clinician and the athlete. But not all heel pain is caused by this, and among the many other potential foot-related maladies, one that often goes unnoticed is Baxter’s nerve entrapment.
Clinicians often overlook Baxter’s nerve entrapment as a source of heel pain. Up to 20% of chronic heel pain can be attributed to it(2). Before diving into more in-depth anatomy, Baxter’s nerve entrapment occurs when the inferior calcaneal nerve gets stuck in a tight spot, usually around the heel area of the foot.
While Baxter’s nerve entrapment doesn’t discriminate, it targets specific groups more than others. Athletes, especially those participating in sports that involve repetitive heel strikes, are often at risk. Runners, basketball players, and dancers beware! Additionally, people with flat feet or a tendency to overpronate may be at greater risk. The subjective assessment is critical to uncover the past medical history and current physical activity load. Furthermore, anatomical variations, such as a cyst or bone spur, or wearing tight-fitting shoes also increase the risk of developing an entrapment. There is also speculation that chronic plantar fasciitis irritates the inferior calcaneal nerve. Despite the high prevalence of foot pain in athletes and non-athletes, foot care is way behind heart, eye, teeth, skin, and nutritional care(3).
The tibial nerve derives from the sciatic nerve and is a major peripheral nerve of the lower limb. It innervates the leg and foot in many ways, including sensation and motor function. It then splits into various branches; the medial calcaneal branch arises within the tarsal tunnel to innervate the skin over the heel. The medial plantar nerve innervates the plantar surface of the medial three-and-a-half digits of the foot (see figure 1).
The lateral plantar nerve, where Baxter’s nerve stems from, innervates the plantar surface of the lateral one-and-a-half digits as well as the motor fibers to the abductor digiti minimi, flexor digitorum brevis, and quadratus plantae. The inferior calcaneal nerve, or Baxter’s nerve, is the first branch of this lateral plantar nerve.
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